JVA Registration
Please fill out this form to register for 2021/2022
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Students first name *
Students last name *
Date of birth *
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Students home address *
Students email address
Mothers name *
Mothers phone number *
Mothers email address *
Fathers name *
Fathers phone number *
Fathers email address *
What school did the student previously attend *
What Shul do you currently attend *
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How did you hear about the Jewish Virtual Academy *
Gender *
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